Palatal swellings ranges from benign to malignant lesions. We present a case of lymphangioma of soft palate

1. DOI: 10.14260/jemds/2014/3815
CASE REPORT
J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 61/Nov 13, 2014 Page 13607
LYMPHANGIOMA OF SOFT PALATE: A CASE REPORT
S. Indira Devi1, Manish Kumar Gupta2, K. V. N. Durga Prasad3, T. Shankar4, Juveria Majid5
HOW TO CITE THIS ARTICLE:
S. Indira Devi, Manish Kumar Gupta, K. V. N. Durga Prasad, T. Shankar, Juveria Majid. “Lymphangioma of Soft
Palate: A case report”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 61, November 13;
Page: 13607-13612, DOI: 10.14260/jemds/2014/3815
ABSTRACT: INTRODUCTION: Lymphangioma is a benign hamartomatous tumor of lymphatic
vessels. Described for the first time by Redenbacher in 1828, currently the lymphangiomas are
classified as malformations and not as neoplasms.1 It has a marked predilection for the head and neck
region, at submandibular and parotid area. Its occurrence at oral cavity is rare and it is most
commonly identified at the anterior two thirds of the tongue. Its occurrence in soft palate is very rare.
Lymphangioma is observed on birth or manifests before 2 years of age2.In the case reported here, the
lesion developed in a patient older than the common age group. At this location, it is clinically
characterized as transparent and generally grouped vesicles3,4 which can be red or purple or blue.
The deep lesions appear as nodular masses of variable color and superficial texture. It can be
classified according to the size of vessels into three types: capillary, cavernous, and cystic
lymphangioma.5 Several types of treatment have been suggested; and the most commonly used
treatments are: surgical excision, application of carbon dioxide laser, cryotherapy using liquid
nitrogen, and sclerosing agents.5 CASE PRESENTATION: A female patient aged about 45 years
presented with bluish swelling near soft palate. Histopathology confirmed diagnosis of
Lymphangioma. DISCUSSION: Windstorm criteria were used to confirm the diagnosis conclusion
lymphangioma of soft palate is a rare entity. This study emphasizes the clinical & histopathological
features that should be considered to confirm clinical Diagnosis and indicate the proper management
for oral lymphangioma.
KEYWORDS: Lymphangioma, soft palate, histopathology.
INTRODUCTION: Lymphangioma of soft palate is a benign condition and is a rare entity. Recently we
encountered a case of swelling of soft palate which turned out be lymphangioma.
CASE HISTORY: A Patient presented with swelling over soft palate and pain since 3 months. The
lesion gradually increased to the present size. No h/o trauma.
On intra oral examination, a bluish colored diffuse swelling of size approximately 3x2 cms
was seen over left part of soft palate, crossing the midline. On palpation, it was soft to cystic in
consistency with few areas palpable as boggy texture. Mildly tender on palpation and ill-defined
borders. Mucosa over the swelling has bluish discoloration. Mucosa over Surrounding structures and
retro molar trigone was normal.
Patient was subjected for Fine Needle Aspiration Cytology (FNAC), which concluded as
Retention Cyst. Computerized Tomography scan was done to see extent of the lesion, any bony
indentations or erosion. No bony indentation or erosion was found.

2. DOI: 10.14260/jemds/2014/3815
CASE REPORT
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Patient was taken up for excision of the mass under GA. The lesion was excised in toto and
with intact mucosal flap technique, wherein mucosa was incised, mass removed, Homeostasis
Secured. Post operatively patient was put on Ryle’s tube feeding for 5 days. There was partial
necrosis of the flap on 5th postoperative day. The necrosed mucosa debrided and post op antibiotic
coverage and gargling with betadine solution was advised. Later ryles tube removed, oral intake of
A diffuse bluish colored swelling of size
3x2 cms seen over left side of soft palate
CT scan not showing any bony erosion

3. DOI: 10.14260/jemds/2014/3815
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food started with liquids and semisolids first. Patient was followed up at intervals of 1 week, later 2
weekly. Complete epithelialization was seen at the end of 6 weeks. No defect in palate was seen.
The lesion excised was sent for histopathological examination. The histological cuts were
examined and stained in hematoxylin and eosin, revealing lymphatic vessels of great diameter
distributed in a conjunctive tissue poorly organized. Therefore, the histopathological diagnosis
confirmed the clinical and surgical diagnosis of lymphangioma.
Patient is being followed from last 3 months. Till date there is no recurrence.
DISCUSSION: Lymphangiomas are hamartomatous, congenital malformations of the lymphatic
System.1,2,6 They are believed to arise from lymph sac sequestration and enlarge due to inadequate
drainage, from lack of communication with the central lymphatic channels or excessive secretion of
lining cells.3
Excised mass
Wound healed well with complete
epithelialization and no palatal defect

4. DOI: 10.14260/jemds/2014/3815
CASE REPORT
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Lymphangioma is observed at birth or mostly presents below 2 years1. In the case reported
here, the lesion developed in a patient older than the common age group which is infrequent.1, 2, 3, 4.
Lymphangioma have a marked predilection for the head and neck region, which accounts for about
75% of all cases. Lymphangiomas have been classified into1:
Lymphangioma simplex (capillary lymphangioma) consists of small, capillary-sized vessels
Cavernous lymphangioma is composed of large, dilated lymphatic vessels
Cystic lymphangioma (cystic hygroma) exhibits large macroscopic cystic spaces.
This is also classified according to the clinical presentation into macrocystic, microcystic and
mixed, combining these two types.1
Oral lymphangiomas occur at various sites, but are most frequently found on the anterior
two-thirds of the tongue, where they often result in macroglossia. The lesion can also present in the
palate, buccal mucosa, gingival, and lips. Uncommon occurrences involve the soft palate and
retromolar region.1,2,6 Clinically, the lesions present superficially as a bluish or purple swellings with
diffuse margins. In oral cavity, the dense conjunctive tissue and the presence of the muscles do not
allowed the vessels great expansion. Consequently, the most common intraoral type is cavernous
lymphangioma.1
The diagnosis of lymphangiomas is not difficult, being mainly clinical. In lesions with atypical
clinical features, a definitive diagnosis should be made through FNA Cyotology or biopsy and
histopathological examination, along with imaging studies which are very useful in confirming the
diagnosis.1 Vascular malformations do not contain hyperplastic cells but consist of progressively
enlarging aberrant and ectatic vessels composed of a particular vascular architecture such as veins,
lymphatic vessels, venules, capillaries, arteries, or mixed vessel types.1,3
Vascular malformations are appropriately named by their predominant vessel type (e.g.,
venous malformations, arteriovenous malformations). In this case it was due to lymphatic vessels and
hence it is termed as lymphatic malformation.
While multiple therapeutic modalities have been described for the treatment of deep
lymphangiomas, such as surgical excision, cryotherapy, electro cauterization, schlerotherapy,
steroids administration, embolization, and laser therapy surgical excision has been the best
alternative for lesions presenting localized growth1,2,5,7,8
Because the lesions described in this case report exhibited a superficial location, we opted for
the surgical removal. After regular follow-up, no sign of relapse was identified.
CONCLUSION: Lymphangiomas of oral cavity are rare particularly of soft palate. Superficial and
localized lesions can be treated by conservative surgical excision. For proper therapy and correct
diagnosis the complete knowledge is essential.

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REFERENCES:
1. Lymphangioma Circumscriptum in an Adult: An Unusual Oral Presentation C. Ganesh, G. S.
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imaging science 2013; 3: 44, published online Oct 29 2013.
2. Lymphangioma of the Palate: A Case Report. Vijayalakshmi S Kotrashetti, MDS; Alka D Kale,
MDS; and Yasmin Satpathy, MDS Jun 2010; 4 (2). Dentistry India.
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Karadeniz. Lymph Angiom A of bucc AL mucos A - A cAse report. International Journal of Dental
clinics.2004; 4 (1): 50 -51.
4. Mandel L. Parotid area lymphangioma in an adult:oral and maxillofacial surgery. 2004; 62 (10):
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5. Marcelo Gadelha Vasconcelos, Bruna Camara Santos, Luciana Cristina Peixoto Lemos, Case
Report on Oral Lymphangiomas. RSBO.2011 July-Sep; 8 (3)-352-6.
6. Mousumi Goswami, Sanjay Singh, S Gokkulakrishnan, Amit Singh. Lymphangioma of the tongue
Natl J Maxillofac Surg. 2011 Jan-Jun; 2 (1): 86–88.
doi:10.4103/0975-5950.85862National journal of maxillofaial surgery.
7. Edwards SP, Helman JI. Oral lymphangioma. E Medicine Web site.
http://emedicine.medscape.com/article/1076948 -overview. Accessed June 9, 2010.
8. Ikeda H, Fujita S, Nonaka M, et al. Cystic lymphangioma arising in the tip of the tongue in an
adult. Int J Oral Maxillofac Surg. 2006; 35 (3): 274-276.
Minor salivary gland with cyst lined by
thin flattend epithelium (HE 40X)
Cystic lesion lined by thin
flattend epithelium (HE 40X)

6. DOI: 10.14260/jemds/2014/3815
CASE REPORT
J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 61/Nov 13, 2014 Page 13612
AUTHORS:
1. S. Indira Devi
2. Manish Kumar Gupta
3. K. V. N. Durga Prasad
4. T. Shankar
5. Juveria Majid
PARTICULARS OF CONTRIBUTORS:
1. Formerly Professor, Department of ENT,
Osmania Medical College, Hyderabad.
2. Assistant Professor, Department of ENT,
Osmania Medical College, Hyderabad.
3. Assistant Professor, Department of ENT,
Osmania Medical College, Hyderabad.
4. Professor, Department of ENT, Osmania
Medical College, Hyderabad.
5. Post Graduate, Department of ENT, Osmania
Medical College, Hyderabad.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Manish Kumar Gupta,
H. No. 564, Road No. 12,
Banjara Hills,
Hyderabad-500034.
Email: drmanishgupta003@gmail.com
Date of Submission: 11/10/2014.
Date of Peer Review: 13/10/2014.
Date of Acceptance: 07/11/2014.
Date of Publishing: 13/11/2014.